Posts Tagged ‘individual health insurance’

You could be one of the millions of Americans getting a refund from your health insurance company soon. The Affordable Care Act has a law called the 80/20 rule, where insurance companies have to spend at least 80% of total premium costs on medical care or improving the quality of health care for consumers. In The Boston Globe’s “Health Insurance Companies Refund $15B to Mass. Consumers,” Chelsea Rice talks about the refunds going out and the companies who will be paying them. The U.S. Department of Health & Human Services released this data showing that Massachusetts consumers will be getting the second highest amount of refunds in the United States. The total refund amount for the U.S. is $332 million, which will pay around $80 a family those those receiving refunds. Florida health insurance companies will be paying the most refunds with $41.5 million owed. Massachusetts residents will be paid out $15 million, which amounts to $133 per family getting a refund.

Almost all of Massachusetts’ residents have health insurance, most through their employer, but 1/4 of them still struggle with the burden of high health insurance costs. The ACA’s 80/20 rule brings transparency and competition to the health insurance marketplace. It also offers greater value to consumers in their health insurance plans. Large group plans have to follow an 80/15 rule. Insurance companies operate more efficiently when they are following this rule by cutting out unnecessary expenses. They have been able to lower premiums throughout the U.S. by $3.8 billion. Companies who do not follow the 80/20 rule during their fiscal year have to refund the excess they spent to consumers in their health insurance plan. Those receiving refunds will get them by August 1 either by check, a discount in next years premium, an account reimbursement or a direct reimbursement through their company.

In Massachusetts, more than 208,000 consumers will be receiving an average refund of $133 per family. This new 80/20 rule has made quite a shift in the amount of upfront value that consumers receive from their health insurance plans. The biggest shift by far has been in the individual health insurance market. Back in 2011, the HHS found that 61% of consumers in the individual market received upfront value from their plans. Just two years later, 81% of people are receiving upfront value from their individual health insurance plans. Ten health insurance companies in Massachusetts will be sending out refunds, including Fallon Community Health Plan, Neighborhood Health Plan Inc. and Tufts Associated HMO. If you are one of the Americans receiving a refund from your health insurance company, look for that in the next week.

The last thing you are worried about when a parent dies is what will happen to your health insurance coverage. But unfortunately for many young people, they also lose their health insurance coverage when their spouse dies. This also holds true for spouses, including those with young children. In the U.S. News & World Report Health article “What to Do When You Lose Your Health Insurance,” Geoff Williams offers up options for those who lose their health insurance unexpectedly. The article gives the example of a 30-year old woman who lost her health insurance coverage when her father passed away in April. She has ulcerative collitis, a bowel disease that could cause serious complications without her medication and doctor visits. She found out that she had lost her health insurance when she tried to fill a prescription and her insurance was declined. It cost her $200 out of pocket just to buy the four pills that she needs for one day.

It’s not common for a 30 year old to have health insurance coverage under her Dad’s plan, so the woman in the example was lucky to have such a perk. In this particular instance, her Dad had carried individual health insurance with his carrier for so long that they allowed him to keep his daughter on his plan to age 31. She would have had to search for health insurance soon anyways, so she was likely already researching her options. If you don’t have health insurance coverage, you can shop for it at any time. The Health Insurance Marketplace open enrollment period is from November 15 to February 15, but the government dates aren’t necessarily written in stone. You can apply for a health insurance plan at any time when you have had a life change that took away your health insurance. You can also apply for health insurance with an individual health insurance company at any time during the year. Most companies have open enrollment periods similar to the government, but for a shorter period of time. You can make changes to your plan during that time, unless you have a life changing event some other time during the year.

Life changing events include death, the birth of a child, marriage, divorce, a change of income, relocation, or the sudden loss of health insurance. If any of these events happen to you, the government gives you a 60 day grace period to obtain health insurance in the exchange. You can get health insurance quotes from multiple companies here. You can also use an agent that works for one health insurance company or a broker that shops the health insurance marketplace for you. The last option is similar to shopping the market for health insurance with comparehealthrates.com. Medicaid and the Children’s Health Insurance Program are available to those with low income. COBRA is a health insurance option for people who have just lost their jobs, and therefore their health insurance coverage. If your parent dies and you lose your health insurance, there are options for you to find health insurance coverage. The woman in the article was able to get her insurance plan extended until August 1 so that her daily medication is covered, so she had a couple months to search for her own health insurance plan.

Hobby Lobby is one of many companies who claim that the Affordable Care Act, aka “Obamacare”, is forcing them to do something they believe is unethical. In the article “Hobby Lobby: The Cost of Not Offering Health Insurance,” Andrew Abela and Irene Kim discuss the Supreme Court case Sebelius v. Hobby Lobby. Hobby Lobby’s argument is that the federal law has forced them to make what they call an impossible decision. They can either offer health insurance with coverage that they believe is unethical or they can pay fines to the government that they say could ruin their finances. A couple Justices have suggested that the company does have a third option which they haven’t considered. They could pay a $2,000 per employee fine and simply not offer their employees health insurance coverage at all. The Justices argue that the company wouldn’t be any worse off than with the first two options.

Hobby Lobby argues that in addition to paying the per employee fine they would also have to increase employee wages so that their employees could go out and purchase individual health insurance plans. But Justice Kagan said that whether the company chooses to offer health insurance plans that are against their religious beliefs or chooses not to offer health insurance to their employees and pay a fine, their costs will be just about the same. That is certainly debatable.

If the company were to stop offering health insurance plans to their employees, they would have to increase employees’ after tax pay by the approximate amount that it would cost for them to purchase their own health insurance. Premiums will cost more for a lot of individual and family plans than the discounted rate that Hobby Lobby would have received for a large group health insurance plan. In addition to higher premiums, individual plans typically have higher deductibles that they company will have to account for in their salary increases. Between the salary increases and the $2,000 per person penalty for 13,000 employees, the article estimates that Hobby Lobby will pay $60 million each year if they choose this option. That estimate is quite a bit more than the company would pay to offer their employees health insurance. But finances are not the only thing the company needs to consider. A loss of health insurance could decrease employee morale, even with a salary increase to pay for individual health insurance. The company also has a religious belief that they need to take care of their employees. Hobby Lobby will likely continue their fight against the federal government forcing them to offer insurance coverage for birth control that is against their religious beliefs.

A recent study done by the Commonwealth Fund found that health insurance premiums have been increasing for years. The nonprofit group performed this study to determine what had been happening in the health insurance industry before the implementation of the Affordable Care Act changes. They wanted to show the public the whole picture so that people aren’t blaming all of the health insurance increases on Obamacare. This information comes from Maggie Fox’s NBC News article, “Health Insurance Premiums Have Been Increasing Since 2008.” They studied health insurance premiums in the private health insurance markets. Those are the individual and family health insurance plans that Americans find and pay for out of their own pocket, not through a group or employer. The study found that health insurance premiums have been steadily increasing since 2008.

Individual insurance premiums increased by at least 10% per year from 2008-2010. We are still waiting to see what the premium prices will be for 2015, but most experts agree that they will be higher than this year’s prices. The study results point out that premium increases really cannot solely be attributed to mandatory changes brought about by the Affordable Care Act because premium prices were rising 10% per year before the law took effect. Premiums almost have to increase because health insurance companies have to cover much more than they covered before the ACA took effect. Insurers can no longer deny coverage to people with preexisting conditions either, so it costs them much more money to offer insurance plans. They can’t exclude maternity coverage from plans or charge cancer patients more for their insurance policies, so premium prices across the board are likely to increase.

State and federal run health insurance exchanges started offering plans this year. Before these exchange plans were an option, an estimated 14 million people bought individual health insurance plans outside of the workplace. This is either because they don’t have a job or their employer doesn’t offer them health insurance coverage. Eight million people have bought insurance plans through the exchanges this year, according to the President’s administration. A Gallup poll found that the number of Americans without health insurance went from 18% in December to 13.4% in May. It’s going to take years before we know the true effect of the Affordable Care Act on the health insurance industry, especially because of the plans that have been allowed to continue offering sub-standard policies for two more years. It will just be important to keep in mind that health insurance plans were rising before the ACA as well. Increases in 2008, 2009 and 2010 were 9.9%, 10.8% and 11.7%, respectively.

On the heels of the Office of the Actuary of the Centers for Medicare and Medicaid Services report detailing premium increases for many small businesses, there is another report saying that individuals are paying more for health insurance as well. According to The Business Journal’s Kent Hoover in his article “Take out subsidies and Obamacare is Really Expensive,” those Americans who are not receiving government subsidies are paying significantly more in health insurance costs. Some Americans qualify for government tax subsidies when they buy an individual or family health insurance plan in the health insurance exchanges. Low and middle income Americans can buy insurance plans through the government website or individual state health insurance exchanges and receive a tax break based on their income level.

But eHealth Inc. just performed a study to see how much health insurance plans cost for those who don’t qualify for the government subsidies. They compared data from before the Affordable Care Act went into effect with plan costs as of February 24 of this year, after the ACA prices took effect. Average individual health insurance plans now are $274 per month. That is a 39% increase from average plan costs before the ACA requirements changed health care. Family plan monthly average costs increased to $663 per month. This is up 56% from the same time last year. The company performing the study sells an array of health insurance plans and wants to highlight what they perceive as the negative changes brought about by the Affordable Care Act. Those who already had affordable health insurance may be negatively affected, while those people who didn’t have health insurance or with very high plan costs receive the benefits of the health care law.

Compare health rates from multiple insurance companies to find the most affordable premiums for you or your family. If you don’t qualify for a government subsidy or have health insurance through your employer, there are countless health insurance plan options available from an array of health insurance companies.

Just a couple decades ago, American retirement plans made a big shift from pensions to 401k’s. Instead of receiving a defined benefit pension, workers started contributing to plans and making their own decisions about how they would receive their money. A lot of people are forecasting a similar change in the health insurance industry over the next 5-10 years. Right now many employers offer health insurance in a defined benefit way. They choose the exact health insurance options and you can choose to pay for the plan or opt to buy your own individual health insurance. Insurance News Net posted an article from The Pittsburgh Post-Gazette’s Bill Toland which says that “In 2020, Workers Will Decide (their own) Health Benefits.”

Many experts believe that the face of health insurance will change dramatically. They forecast that people will shop online and choose the specific health insurance options that they want for themselves from private exchanges. Companies will pay a certain stipend to their employees via a health account and that will go towards their health insurance plan costs. If people choose a health insurance plan that is more than their employer stipend, they will have to pay the rest of the bill themselves. They will shop in online private health insurance exchanges run by health insurers, like Highmark, or benefits consultants or brokers.. If an insurance company is running the exchange, all of the plans will be from them. But if the exchange is run by benefits consultants or brokers, there will be plans from multiple insurance companies. Plans will differ in prices and coverage. Each exchange will likely offer around 6-10 different plans.

It was easier for large companies to make the pensions switch because they almost immediately saw huge cost savings. It is a little different with the health insurance plans because although they will not see huge cost savings, they will see a large reduction in the amount of administration. They are also offering better benefits to their employees, making them more competitive as employers. But small and mid-sized employers will see even more benefits initially than the larger companies. Experts predict that many smaller companies will make this switch to private exchanges in the next year and a half. Larger companies will switch as well, but it will take a large employer like McDonalds or WalMart making the big move before many other make the jump as well.

There is a lot of false information circling around about Affordable Care Act deadlines. If you’ve been told that the deadline for obtaining health insurance coverage is January 1, don’t worry if you haven’t found a plan yet. January 1 is actually the first day that you can take advantage of subsidized health insurance coverage if you have signed up in time and paid your premium in time. It is not a deadline, but an opportunity, according to Dr. David Blumenthal. This information comes from Insurance News Net’s “The Big Deadline for Coverage is March 31.” Much of the confusion about deadlines stems from the fact that they have been changing since this health insurance law took effect. Even the January 1 deadline has been extended to the following Tuesday for consumers shopping on the healthcare.gov website.

You have until March 31 to obtain health insurance coverage before you will actually be penalized for not having insurance. Penalties will come when you file your taxes for 2014. If you miss the January 1 deadline, which is now January 10, you won’t be penalized for anything. Basically, you just aren’t taking advantage of being insured with a federal subsidy as soon as you could. But with millions of uninsured Americans, not all of them are searching for health insurance from the state or federal health insurance exchanges. Not everyone will qualify for a subsidy. If you do qualify for a subsidy, buying health insurance through a state or federal exchange is likely in your best interest. There are many uninsured Americans who do not qualify for tax subsidies, so they don’t have to worry about the January deadline. They do have to worry about the March 31 deadline though. In order to avoid receiving a penalty when you file taxes next year, shop for an individual health insurance plan before the March 31 deadline.

College students often underestimate the importance of health insurance. They believe that they are young and healthy and don’t want to “waste” money from their low-paying jobs to pay for something of which they can’t see the immediate value. ABC News recently published Bankrate’s article, “Top 6 Health Insurance Options for College Students,” by Chris Kissell. The article stresses the importance of health insurance to college students and highlights the fact that it is easier than ever for them to find a health insurance plan. There are more options than ever before.

Perhaps the simplest option is to stay on their parents’ health insurance plan. This won’t work for someone whose parents are uninsured, but everyone else under the age of 26 can now stay on their parents’ plans. Sometimes this is tricky if students go to a college out of state though. Make sure that there is somewhere to see a doctor in-network or try to schedule your doctors appointments when you are home for a break. If remaining on your parents’ health plan isn’t an option, try to sign up for a health insurance plan through your college. Many colleges offer plans to students and the cost can even be included with your tuition and paid by student loans. Some college plans have limited coverage though, so read the details carefully to know what you are getting.

Another health insurance option is to shop in a health insurance exchange created by Obamacare. Most students have low enough income that they can qualify for a subsidy to help them pay for their plan. Students can also sign up for something called ‘catastrophic coverage’ through the health insurance exchanges. These plans have low premiums and high deductibles. Preventative care is covered, but beyond that deductibles are high. This type of plan might work for some students, but one health ailment could lead to high medical bills.

As some states expand their Medicaid programs, students may be eligible to apply for this government health insurance. Their entire family’s income would have to meet the poverty qualifications for them to be eligible for Medicaid. Not all states are expanding their Medicaid programs, so this won’t be an option for all low-income college students. Most Americans will be required to have health insurance or face a fine from the government. But college students earning less than $10,000, exempting them from filing income taxes, won’t be forced to carry health insurance. Forgoing health insurance can be dangerous and costly though, so search for an individual health insurance plan if none of the other options work for you.

There are a lot of factors that go into determining health insurance premium costs. They aren’t always easy for the average consumer to figure out, but Money Crashers has put together a list of the “10 Factors That Affect Your Health Insurance Premium Costs.” Kira Botkin says that insurance companies first place a value on your risk profile, which is made up of information from your insurance application and your medical history. Some things in your risk profile are under your control, while others are not. Once the company does extensive research to determine your risk profile, they compare it with company benchmarks and decide whether they will offer you health insurance coverage. Your premium is then determined based on your individual risk factors.

The first group of risk factors is that of the medical and physical variety, some of which you have full control over. Number one is your BMI, or Body Mass Index. People with a high BMI are almost always charged more for individual health insurance policies. They have a higher risk for diseases like diabetes and heart disease and women with high BMI’s can have complicated pregnancies. Whether or not you smoke or chew tobacco will affect the price of your health insurance. Some companies deny you altogether, but many offer plans with higher premiums and cover the cost of programs to help you stop smoking if they are prescribed by a doctor. Gender and age are the next two factors affecting your insurance premiums. Women often pay more for health insurance because they go to the doctor more often, fill more prescriptions, and get more diseases on average. Maternity costs are also very high for women of child bearing age. Speaking of age, younger people often get lower health insurance premiums because they visit the doctor less and typically have fewer health conditions.

Pre-existing medical conditions have been in the news headlines a lot lately. Many insurance companies wouldn’t even cover people with these pre-existing conditions until the Affordable Care Act started requiring insurers to do so. Any pre-existing medical conditions like asthma or a cancer history will increase the cost of your insurance premiums. Although you have no control over your family health history, family history does often play a role in the cost of your health insurance premiums.

The second group of risk factors pertain to your lifestyle and personal health. Your job plays a part in determining your insurance premiums. Those in very risky or dangerous jobs might be charged more because they could get injured. Also, people who work in very sedentary jobs are often charged an increased premium because of their increased likelihood to develop cardiovascular disease. Where you live can also affect how much you pay for health insurance. If your area has more unhealthy people and a more sedentary lifestyle, you could pay more for insurance, even if you are healthy. Married people pay less for health insurance than single people, on average. Married couples are often healthier and live longer than unmarried people. Finally, whether or not you have been uninsured in the past can affect your new health insurance premium. If you were uninsured or are just now shopping for your own insurance policy, you will likely have a higher premium.

Be healthy and control the things that you can control in your lifestyle to give yourself the best chance at a lower health insurance premium. Compare insurance companies and policies and do your homework before choosing an individual health insurance plan. Some risk factors are out of your control, but take charge of those that are not.

There is good news for people with individual and small group health insurance plans Illinois. Many of the more than 185,000 people who received cancellation notices from their insurance company will have a year long reprieve from finding new coverage. After an outcry from Americans, President Obama has urged state insurance regulators to make exceptions to the Affordable Care Act requirements. Many existing health insurance plans do not meet all of the requirements, causing hundreds of thousands of people to get a cancellation notice. If your insurance plan was effective prior to October 1 of this year, you will now have until October 1 of 2014 to select a new insurance plan. This is great news to Americans who were scrambling to make health care plan decisions by January 1. WGN’s Peter Frost discussed the details for Illinois residents in the story “Illinois to let companies sell existing health insurance plans.”

Blue Cross and Blue Shield of Illinois, the largest insurance company in the state, said that they will be contacting people who received cancellation notices to tell them their new options. More than 475,000 people in Illinois had individual health insurance policies as of data collected in 2012. Some of the people whose plans do not meet Affordable Care Act requirements will receive federal tax credits to help pay for new insurance plans. But many others are upset because their new plan options cost double what their prior health insurance plans cost. So far, 15 states have told their insurers that it’s okay to extend current insurance plans for another year. Some states are not allowing this plan extension though, despite the President’s request for them to do so. Some insurance companies worry that extending old plans will keep too many people out of the health insurance exchanges, which could raise those plan costs. Those people who are buying plans in the health insurance exchanges have until December 23 of this year to purchase a plan that will go into effect January 1.